title: Adjuvant chemotherapy in elderly women with breast cancer: patients' perspectives on information giving and decision making.
abstract: BACKGROUND
  Decisions about adjuvant chemotherapy in older women with early stage breast cancer (EBC) are often challenging. Uncertainty about benefits due to limited data about treatment efficacy and outcomes complicates decision making. This qualitative study explored older patients' experiences and preferences towards information giving and ultimate decisions about adjuvant chemotherapy.
  
  
  METHODS
  Clinicians from 24 UK breast cancer teams reported on adjuvant chemotherapy decisions for women aged ≥70 years with EBC from April 2010 to December 2011. Women who were offered chemotherapy were invited to participate in structured interviews. Self-reported quality of life (QoL) and functional ability were assessed. Qualitative methods were used to identify themes associated with information giving and decision making.
  
  
  RESULTS
  A total of 58/95 eligible women (61%) participated. Median age was 73 years (range 70-83). Mean total scores for QoL and functional ability were average. The majority of women preferred to make their treatment decisions collaboratively with a clinician (59%) or on their own (19%). The main reasons influencing decisions to accept chemotherapy were categorised as prevention of recurrence and clinician recommendation. Side effects, length of treatment, impact on QoL, low survival benefits and clinician recommendation influenced decisions to decline chemotherapy. The majority (80%) were satisfied with information provision, the communication with their clinician and explanation of treatment.
  
  
  CONCLUSIONS
  Older women with EBC preferred to be involved in clinical decision making. Clinician recommendation plays a significant role in either accepting or declining chemotherapy. Well-informed decision making and effective communication between clinicians, older women and their family members are therefore important.
authors.affiliation: Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, UK.
authors.forename: Helena
authors.initials: H
authors.lastname: Harder
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballinger
authors.forename: Carolyn
authors.initials: C
authors.lastname: Langridge
authors.forename: Alistair
authors.initials: A
authors.lastname: Ring
authors.forename: Lesley J
authors.initials: LJ
authors.lastname: Fallowfield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D017024:Chemotherapy, Adjuvant / Q000523:psychology; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D033181:Information Dissemination; D010358:Patient Participation / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011788:Quality of Life
keywords: cancer; chemotherapy; decision making; older women; oncology